Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
Department of ECMO, University of Michigan, Ann Arbor, MI.
Pediatr Crit Care Med. 2018 Jul;19(7):665-671. doi: 10.1097/PCC.0000000000001555.
The purpose of this study is to describe the functional status of survivors from extracorporeal cardiopulmonary resuscitation instituted during in-hospital cardiac arrest using the Functional Status Scale. We aimed to determine risk factors leading to the development of new morbidity and unfavorable functional outcomes.
This was a single-center retrospective chart review abstracting patient characteristics/demographic data, duration of cardiopulmonary resuscitation, duration of extracorporeal membrane oxygenation support, as well as maximum lactate levels within 2 hours before and after extracorporeal cardiopulmonary resuscitation. Cardiac arrest was defined as the administration of chest compressions for a nonperfusing cardiac rhythm. Extracorporeal cardiopulmonary resuscitation was defined by instituting extracorporeal membrane oxygenation during active chest compressions. Functional Status Scale scores were calculated at admission and on hospital discharge for patients who survived.
Patients admitted in the pediatric cardiac ICU at C.S. Mott Children's Hospital from January 1, 2005, to December 31, 2015.
Children less than 18 years who underwent extracorporeal cardiopulmonary resuscitation.
Not applicable.
Of 608 extracorporeal membrane oxygenation events during the study period, 80 were extracorporeal cardiopulmonary resuscitation (14%). There were 40 female patients (50%). Median age was 40 days (interquartile range, 9-342 d). Survival to hospital discharge was 48% (38/80). Median Functional Status Scale score at admission was 6 (interquartile range, 6-6) and at hospital discharge 9 (interquartile range, 8-11). Out of 38 survivors, 19 (50%) had a change of Functional Status Scale score greater than or equal to 3, that is consistent with new morbidity, and 26 (68%) had favorable functional outcomes with a change in Functional Status Scale score of less than 5.
This is the first extracorporeal cardiopulmonary resuscitation report to examine changes in Functional Status Scale from admission (baseline) to discharge as a measure of overall functional outcome. Half of surviving patients (19/38) had new morbidity, while 68% (26/38) had favorable outcomes. Lactate levels, duration of cardiopulmonary resuscitation, and duration of extracorporeal membrane oxygenation were not found to be risk factors for the development of new morbidity and poor functional outcomes. Functional Status Scale may be used as a metric to monitor improvement of extracorporeal cardiopulmonary resuscitation outcomes and help guide research initiatives to decrease morbidity in this patient population.
本研究旨在使用功能状态量表描述体外心肺复苏（ECPR）后院内心搏骤停幸存者的功能状态。我们旨在确定导致新发病和不良功能结局的危险因素。
这是一项单中心回顾性图表审查，提取患者特征/人口统计学数据、心肺复苏持续时间、体外膜氧合支持时间以及 ECPR 前后 2 小时内的最大乳酸水平。心脏骤停定义为给予非灌注性心脏节律的胸外按压。ECPR 的定义是在积极进行胸外按压时实施体外膜氧合。对于存活的患者，在入院时和出院时计算功能状态量表评分。
2005 年 1 月 1 日至 2015 年 12 月 31 日期间，在密歇根州立大学儿童医院儿科心脏重症监护病房（C.S. Mott Children's Hospital）收治的患者。
年龄小于 18 岁且接受过 ECPR 的儿童。
不适用。
在研究期间，608 次体外膜氧合事件中，80 次为 ECPR（14%）。有 40 名女性患者（50%）。中位年龄为 40 天（四分位距，9-342 天）。出院时存活率为 48%（38/80）。入院时的中位功能状态量表评分为 6（四分位距，6-6），出院时为 9（四分位距，8-11）。在 38 名幸存者中，有 19 名（50%）功能状态量表评分变化≥3，即存在新发病，26 名（68%）功能状态量表评分变化<5，功能结局良好。
这是第一篇报告 ECPR 后功能状态量表变化（入院时为基线）作为整体功能结局衡量标准的研究。一半的存活患者（19/38）有新发病，68%（26/38）有良好的结局。乳酸水平、心肺复苏持续时间和体外膜氧合持续时间均未被发现是新发病和不良功能结局发展的危险因素。功能状态量表可用作监测 ECPR 结局改善的指标，并有助于指导减少该患者人群发病率的研究计划。
